Elimination disorders involve eliminating feces – encopresis – or urine -enuresis, and they usually occur in children who struggle with going to the bathroom. Although it is not uncommon for kids to have occasional accidents, when these behaviors occur for longer than 3 months, particularly in children older than 5 years, they might have an elimination disorder.
Many predisposing factors include genetics, psychological factors, delayed or lax toilet training, and psychosocial stress.
Associated symptoms include low self-esteem, loss of appetite, abdominal pain, decreased interest in physical activity, and withdrawal from friends and family. Children often feel ashamed and avoid situations that can lead to embarrassing accidents like at school or camps.
Regardless of symptoms, this can be a painful experience for many kids. From a child’s perspective, it would be rational to avoid using the bathroom at all costs to avoid further pain. This can result in complications as the stool becomes more difficult to pass later on.
Enuresis
Enuresis involves individuals repeatedly wetting the bed or clothing, and can be either involuntary or intentional. It is common for young children to have poor bladder control. If a child is around the age of 5 and experiences urinary incontinence on a regular basis, they may have enuresis. The criteria for enuresis are as follows:
● Repeated urination in bed or clothes
● The behavior must occur twice a week for 3 months and impair significant functioning areas, such as social or academic
● Physical conditions must be ruled out before an official diagnosis is made
3 types of enuresis
The nocturnal-only subtype of enuresis, which is sometimes referred to as monosymptomatic enuresis, is the most common and involves incontinence only during nighttime sleep, typically during the first few hours of the night.
Nocturnal enuresis is more common in boys. Elimination often occurs in the first one-third of the night, caused by behavior, high stress or anxiety, or an underlying physical issue.
The diurnal- (daytime) only subtype occurs in the absence of nocturnal enuresis and may be referred to as urinary incontinence. Diurnal enuresis can be a source of embarrassment and teasing from peers.
The nocturnal-and-diurnal subtype is a combination of the first 2, and occurrences happen any time, whether day or night.
Enuresis Therapy
The most popular therapeutic approaches to enuresis are conditioning therapy with a moisture alarm, including medication. A bed-wetting alarm has a moisture sensor to alert the child of the start of urination. Often, a combination of treatments is used.
Enuresis is typically settled in adolescence and has a 1% rate in adulthood. Nonetheless, it can produce severe psychological stress for a child and may have a physical cause and should be treated. The longer enuresis persists, the higher the risk of the frequency of urination increases.
Encopresis
Second is encopresis, and it requires repeated passage of feces into inappropriate places like in the clothes or on the floor. Children with encopresis frequently experience constipation as well.
Encopresis is essentially a repeated behavior, where feces are found in inappropriate places. This is involuntary in nature but can be intentional in some cases. If the passage is involuntary, it is often related to impaction and retention with a resultant overflow.
Encopresis may result from a change in diet, difficulty with the process of toilet training, or stress. The process of toilet training is typically a natural transition for families but also has the potential to cause emotional distress and turmoil for many.
Encopresis Symptoms
There are several key symptoms to keep in mind in the diagnosis of encopresis. Included in this list are the following.
● Occasional passage of very large stools
● Secretive behavior associated with the act of having a bowel movement ● Inability to retain feces (bowel incontinence)
● Children with encopresis seem oblivious to either stool staining of their clothes or the heavy stool odor they produce.
● The passage of stool in inappropriate places (for example, in the child’s clothing) ● Constipation and/or hard stools
Treatment
Most cases of enuresis are treated through behavioral therapy, although medication may be beneficial in some cases. Working together with a mental health professional to develop a plan for behavioral change can be educational for the child and family, and can work to decrease any symptoms of depression or anxiety.
Another effective approach is to help the child better comprehend the problem and maintain regular bathroom routines. A change in diet and the use of laxatives may also be beneficial if suggested by a medical professional. Alternative treatments include biofeedback, enhanced toilet training (ETT), and hypnotherapy.
